Listening to the Heart of a Woman

Peg Johnston

Listening to a woman talk about her decision makes the public abortion debate seem irrelevant. A discourse that embodied women's experiences would change the abortion debate and help women who are isolated in their decision-making.

If the proverbial Martians were to come to Earth, and specifically to the United States, they would naturally be interested in the dominant conflicts on the planet as the best way to learn about us. When they got to the abortion conflict, they would be perplexed that the most impassioned partisans were not those who personally decided to have or not have an abortion. And there’s a lot to learn about that observation.

What is missing in the abortion debate, including the Common Ground discussion, are the women themselves who have had abortions, or for that matter, who decided to parent or make an adoption plan.  You would expect that patients who identified as pro choice would choose abortion as needed without a lot of conflict. You would think that those women who were against abortion wouldn’t have one. You would be wrong on both counts.

When you sit with women on a daily basis as I, and most abortion care workers, do, you will soon learn that “until you understand the heart of a woman, nothing about abortion makes any sense at all.” Dr. George Tiller taught us that mantra, which is why he was so beloved by our community. A day or two listening to women talk about their decisions will make everything about the public abortion debate seem completely irrelevant.

Take Catherine (not her real name) who wrote on her chart last week: “Yes (it was a difficult decision) because it is wrong.” You might think Catherine was in the wrong place, but what I heard when I listened closely was a complex, thoughtful decision that considered her family and the needs of each of her kids, the financial prospects for her and her husband, and how she might feel about her choice later on, just for starters. I was so impressed with her process that progressed from a simplistic worldview of right/wrong to a more nuanced, ‘what’s right for me and my family?’ I also witnessed her courage in facing down the long held, but unexamined beliefs she had learned from her family. Still, she would not talk to them about her decision, physically recoiling at just the thought of it.

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In this she is not alone. “What does it take to silence 45 million women?” many of us have asked. We know that the 30+ year campaign to stigmatize abortion is working remarkably well. It’s what keeps a woman from talking to her best friend, her husband, her doctor, or her minister. It doesn’t change people’s minds; rather, it’s how they are silenced. So, no wonder no one gets to really understand why more than1 million women every year choose to terminate their pregnancies! Imagine if there was only one story about divorce—instead of knowing women who were relieved to move on, traumatized for a long time, or should have gotten a divorce earlier, we only hear about the adulterer.

The problem is that only a few of us hear these incredible stories of people’s real lives. Aside from the mental health implications of stigmatizing a life event that 45 million people share, the silencing of the abortion experience has distorted the debate. Recently conservative blogger Andrew Sullivan acknowledged that women’s stories, written as comments on Dr. Tiller’s murder, changed how he viewed the issue. “Some of these situations are really tragic,” he said. “Duh,” we said in unison.

Even more tragically, there are very few opportunities to hear, really hear, women’s experiences of abortion, or indeed, their experience of unintended pregnancy and decision-making. Abortion care workers (and I include those who help women at abortion funds, family planning clinics, talklines etc) are like priests in a confessional. The public can sometimes listen into the stories they hear at blogs like or the abortioneers, but there are not many opportunities to hear more than partisan sound bites. A pregnancy decision is so rich with multiple layers of feeling, concerns, and ethics that it is a shame that the public can’t access them. A discourse that embodied these experiences would completely change the abortion debate and would significantly help women who are isolated in their decision-making.

Imagine if women were invited to use existing online public engagement technology so that our deeply conflicted society can try to understand the “heart of a woman.” So that this doesn’t turn into which side can log in faster to a FOX poll, the process would be designed to tease out the most complete story. A scientifically designed survey would invite women who have had an abortion to answer questions as well as to contribute a narrative about the significance of the abortion decision or experience in their lives. These questions would encourage reflection on various aspects of the abortion decision, such as the needs of children, her or her partner’s readiness for parenting, her concerns about the impact of a child on her relationship with partner or family, financial issues, educational goals, religious or spiritual beliefs, support, or lack thereof, for the woman’s moral agency, and societal attitudes toward various pregnancy outcomes (abortion, adoption, single parenthood, etc.)  

A content analysis would identify important themes. This qualitative approach is not a battle of numbers but will allow everyone to understand the range of factors in the decision making process as well as barriers to each option a woman considers. Instead of opinions we will be soliciting experiences.

Those who are making policy about funding, state mandated waiting periods, and other restrictions might just gain perspective from women themselves about what was helpful and what might have been more useful to them in their decision-making. For instance, what kinds of support would have contributed to their emotional health? What information would have been helpful? Were state and federal laws a help or a hindrance? What presentation of risk factors most often leads to negative mental health outcomes? What is the impact of the societal stigma placed on abortion in terms of healthy outcomes? What are the special needs of young women, those experiencing domestic violence, or those with other identified risk factors such as prior emotional conditions?

Just as any visiting Martian can tell you, the solution to the conflict does not come from the partisans on either side. It comes from the truths of the people who are living with the consequences of public policy. When women’s experiences, not just bumper sticker slogans, are part of the debate then—and only then– will common ground make any sense at all.

News Politics

Clinton Campaign Announces Tim Kaine as Pick for Vice President

Ally Boguhn

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

The Clinton campaign announced Friday that Sen. Tim Kaine (R-VA) has been selected to join Hillary Clinton’s ticket as her vice presidential candidate.

“I’m thrilled to announce my running mate, @TimKaine, a man who’s devoted his life to fighting for others,” said Clinton in a tweet.

“.@TimKaine is a relentless optimist who believes no problem is unsolvable if you put in the work to solve it,” she added.

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

Kaine signed two letters this week calling for the regulations on banks to be eased, according to a Wednesday report published by the Huffington Post, thereby ”setting himself up as a figure willing to do battle with the progressive wing of the party.”

Charles Chamberlain, executive director of the progressive political action committee Democracy for America, told the New York Times that Kaine’s selection “could be disastrous for our efforts to defeat Donald Trump in the fall” given the senator’s apparent support of the Trans-Pacific Partnership (TPP). Just before Clinton’s campaign made the official announcement that Kaine had been selected, the senator praised the TPP during an interview with the Intercept, though he signaled he had ultimately not decided how he would vote on the matter.

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Kaine’s record on reproductive rights has also generated controversy as news began to circulate that he was being considered to join Clinton’s ticket. Though Kaine recently argued in favor of providing Planned Parenthood with access to funding to fight the Zika virus and signed on as a co-sponsor of the Women’s Health Protection Act—which would prohibit states and the federal government from enacting restrictions on abortion that aren’t applied to comparable medical services—he has also been vocal about his personal opposition to abortion.

In a June interview on NBC’s Meet the Press, Kaine told host Chuck Todd he was “personally” opposed to abortion. He went on, however, to affirm that he still believed “not just as a matter of politics, but even as a matter of morality, that matters about reproduction and intimacy and relationships and contraception are in the personal realm. They’re moral decisions for individuals to make for themselves. And the last thing we need is government intruding into those personal decisions.”

As Rewire has previously reported, though Kaine may have a 100 percent rating for his time in the Senate from Planned Parenthood Action Fund, the campaign website for his 2005 run for governor of Virginia promised he would “work in good faith to reduce abortions” by enforcing Virginia’s “restrictions on abortion and passing an enforceable ban on partial birth abortion that protects the life and health of the mother.”

As governor, Kaine did support some existing restrictions on abortion, including Virginia’s parental consent law and a so-called informed consent law. He also signed a 2009 measure that created “Choose Life” license plates in the state, and gave a percentage of the proceeds to a crisis pregnancy network.

Regardless of Clinton’s vice president pick, the “center of gravity in the Democratic Party has shifted in a bold, populist, progressive direction,” said Stephanie Taylor, co-founder of the Progressive Change Campaign Committee, in an emailed statement. “It’s now more important than ever that Hillary Clinton run an aggressive campaign on core economic ideas like expanding Social Security, debt-free college, Wall Street reform, and yes, stopping the TPP. It’s the best way to unite the Democratic Party, and stop Republicans from winning over swing voters on bread-and-butter issues.”

Roundups Sexual Health

This Week in Sex: The Sexually Transmitted Infections Edition

Martha Kempner

A new Zika case suggests the virus can be transmitted from an infected woman to a male partner. And, in other news, HPV-related cancers are on the rise, and an experimental chlamydia vaccine shows signs of promise.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Zika May Have Been Sexually Transmitted From a Woman to Her Male Partner

A new case suggests that males may be infected with the Zika virus through unprotected sex with female partners. Researchers have known for a while that men can infect their partners through penetrative sexual intercourse, but this is the first suspected case of sexual transmission from a woman.

The case involves a New York City woman who is in her early 20s and traveled to a country with high rates of the mosquito-borne virus (her name and the specific country where she traveled have not been released). The woman, who experienced stomach cramps and a headache while waiting for her flight back to New York, reported one act of sexual intercourse without a condom the day she returned from her trip. The following day, her symptoms became worse and included fever, fatigue, a rash, and tingling in her hands and feet. Two days later, she visited her primary-care provider and tests confirmed she had the Zika virus.

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A few days after that (seven days after intercourse), her male partner, also in his 20s, began feeling similar symptoms. He had a rash, a fever, and also conjunctivitis (pink eye). He, too, was diagnosed with Zika. After meeting with him, public health officials in the New York City confirmed that he had not traveled out of the country nor had he been recently bit by a mosquito. This leaves sexual transmission from his partner as the most likely cause of his infection, though further tests are being done.

The Centers for Disease Control and Prevention (CDC)’s recommendations for preventing Zika have been based on the assumption that virus was spread from a male to a receptive partner. Therefore the recommendations had been that pregnant women whose male partners had traveled or lived in a place where Zika virus is spreading use condoms or abstain from sex during the pregnancy. For those couples for whom pregnancy is not an issue, the CDC recommended that men who had traveled to countries with Zika outbreaks and had symptoms of the virus, use condoms or abstain from sex for six months after their trip. It also suggested that men who traveled but don’t have symptoms use condoms for at least eight weeks.

Based on this case—the first to suggest female-to-male transmission—the CDC may extend these recommendations to couples in which a female traveled to a country with an outbreak.

More Signs of Gonorrhea’s Growing Antibiotic Resistance

Last week, the CDC released new data on gonorrhea and warned once again that the bacteria that causes this common sexually transmitted infection (STI) is becoming resistant to the antibiotics used to treat it.

There are about 350,000 cases of gonorrhea reported each year, but it is estimated that 800,000 cases really occur with many going undiagnosed and untreated. Once easily treatable with antibiotics, the bacteria Neisseria gonorrhoeae has steadily gained resistance to whole classes of antibiotics over the decades. By the 1980s, penicillin no longer worked to treat it, and in 2007 the CDC stopped recommending the use of fluoroquinolones. Now, cephalosporins are the only class of drugs that work. The recommended treatment involves a combination of ceftriaxone (an injectable cephalosporin) and azithromycin (an oral antibiotic).

Unfortunately, the data released last week—which comes from analysis of more than 5,000 samples of gonorrhea (called isolates) collected from STI clinics across the country—shows that the bacteria is developing resistance to these drugs as well. In fact, the percentage of gonorrhea isolates with decreased susceptibility to azithromycin increased more than 300 percent between 2013 and 2014 (from 0.6 percent to 2.5 percent).

Though no cases of treatment failure has been reported in the United States, this is a troubling sign of what may be coming. Dr. Gail Bolan, director of CDC’s Division of STD Prevention, said in a press release: “It is unclear how long the combination therapy of azithromycin and ceftriaxone will be effective if the increases in resistance persists. We need to push forward on multiple fronts to ensure we can continue offering successful treatment to those who need it.”

HPV-Related Cancers Up Despite Vaccine 

The CDC also released new data this month showing an increase in HPV-associated cancers between 2008 and 2012 compared with the previous five-year period. HPV or human papillomavirus is an extremely common sexually transmitted infection. In fact, HPV is so common that the CDC believes most sexually active adults will get it at some point in their lives. Many cases of HPV clear spontaneously with no medical intervention, but certain types of the virus cause cancer of the cervix, vulva, penis, anus, mouth, and neck.

The CDC’s new data suggests that an average of 38,793 HPV-associated cancers were diagnosed each year between 2008 and 2012. This is a 17 percent increase from about 33,000 each year between 2004 and 2008. This is a particularly unfortunate trend given that the newest available vaccine—Gardasil 9—can prevent the types of HPV most often linked to cancer. In fact, researchers estimated that the majority of cancers found in the recent data (about 28,000 each year) were caused by types of the virus that could be prevented by the vaccine.

Unfortunately, as Rewire has reported, the vaccine is often mired in controversy and far fewer young people have received it than get most other recommended vaccines. In 2014, only 40 percent of girls and 22 percent of boys ages 13 to 17 had received all three recommended doses of the vaccine. In comparison, nearly 80 percent of young people in this age group had received the vaccine that protects against meningitis.

In response to the newest data, Dr. Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center, told HealthDay:

In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer. Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe.

Making Inroads Toward a Chlamydia Vaccine

An article published in the journal Vaccine shows that researchers have made progress with a new vaccine to prevent chlamydia. According to lead researcher David Bulir of the M. G. DeGroote Institute for Infectious Disease Research at Canada’s McMaster University, efforts to create a vaccine have been underway for decades, but this is the first formulation to show success.

In 2014, there were 1.4 million reported cases of chlamydia in the United States. While this bacterial infection can be easily treated with antibiotics, it often goes undiagnosed because many people show no symptoms. Untreated chlamydia can lead to pelvic inflammatory disease, which can leave scar tissue in the fallopian tubes or uterus and ultimately result in infertility.

The experimental vaccine was created by Canadian researchers who used pieces of the bacteria that causes chlamydia to form an antigen they called BD584. The hope was that the antigen could prompt the body’s immune system to fight the chlamydia bacteria if exposed to it.

Researchers gave BD584 to mice using a nasal spray, and then exposed them to chlamydia. The results were very promising. The mice who received the spray cleared the infection faster than the mice who did not. Moreover, the mice given the nasal spray were less likely to show symptoms of infection, such as bacterial shedding from the vagina or fluid blockages of the fallopian tubes.

There are many steps to go before this vaccine could become available. The researchers need to test it on other strains of the bacteria and in other animals before testing it in humans. And, of course, experience with the HPV vaccine shows that there’s work to be done to make sure people get vaccines that prevent STIs even after they’re invented. Nonetheless, a vaccine to prevent chlamydia would be a great victory in our ongoing fight against STIs and their health consequences, and we here at This Week in Sex are happy to end on a bit of a positive note.